Everything About Xerostomia

Xerostomia and the Challacombe Scale

• Xerostomia and the Challacombe Scale is presented by Julie Watson

GDC Learning Outcomes

• The presentation references several GDC (General Dental Council) learning outcomes

Activity 1

• Compare and contrast your role and clinical findings for a patient presenting with a Challacombe Scale of 1-3 with a patient presenting with a Challacombe Scale of 9

Activity 2

• Design a Mind Map titled Exploring Xerostomia

Activity 3

• Identify 10 prescription medications that may cause a dry mouth, using the online BNF (British National Formulary)

Learning Outcomes of this session

• Discuss the signs and symptoms of xerostomia
• State the causes of xerostomia, both persistent and temporary
• Define the difference between responders and non-responders
• Recommend appropriate products to aid non-responders
• Clearly outline a package of care for these patients
• Discuss and use the Challacombe Scale

Definition of Xerostomia

• Xerostomia is a persistent or temporary reduction or absence of saliva
• This is due to factors that may alter or damage the flow of saliva in the oral cavity, predisposing to certain oral conditions
• The resulting saliva may have an altered composition

Clinical Signs and Problems

• Fissured Tongue
• Oral Candida
• Dry Mucosa
• Thick Saliva
• Halitosis
• Affected Taste
• Sore Throat
• Ulcerations
• High Caries Incidence
• Increased Periodontitis

Systemic Manifestations

• Patients may be suffering with more than just a dry mouth, be aware when giving oral hygiene instruction
• This may not be their number one issue

Persistent Causes of Xerostomia

• HIV
• Sjögren's Syndrome
• Irradiation
• Diabetes
• Sarcoidosis
• Amyloidosis
• Age Changes
• Kidney Disease
• Absent salivary gland

Temporary Causes of Xerostomia

• Duct Obstruction
• Infection/Inflammation of the glands
• Psychogenic Disorders
• Mouth Breathing
• Prescription drugs
• Alcoholism
• Smoking
• Dehydration

Two Types of Patient Care

• Types are; The responder, The Non Responder

The Responder

• These patients still have some salivary gland activity
• It may be possible to stimulate their flow

The Non Responder

• These patients have no gland activity
• It is not possible to stimulate their flow
• For these patients, alternative methods of lubricating the mouth have to be found

Our Role

• Fluoride Treatment
• Oral Hygiene Instruction
• Dietary Advice
• Smoking Cessation
• Regular Debridement
• Regular Examinations
• Complete a Challacombe Scale

The Challacombe Scale

• Developed by King's College London Dental Institute
• Produces a clinical oral dryness score, (CODS)
• Enables the clinician to quantify the severity of xerostomia
• Allows the patient to be treated accordingly
• The scale is named after Professor Stephen Challacombe, oral medicine consultant
• Introduced in 2011

How the Challacombe Scale Works

• Factors are used to evaluate the dryness of the mouth
• The presence of each accrues one point
• As the mouth becomes drier, each feature is often seen in sequence with the score progressively increasing
• Scores may change, for better or worse
• Allows monitoring
• Referral and assessment is required for scores of 7 or more

Procedure and Interpretation of Results

• 1: Mirror sticks to buccal mucosa
• 2: Mirror sticks to tongue
• 3: Saliva frothy
• 4: No saliva pooling in the floor of the mouth
• 5: Tongue shows generalised shortened papillae
• 6: Altered gingival architecture
• 7: Glassy appearance of oral mucosa especially palate
• 8: Tongue lobulated/fissured
• 9: Cervical cavitations on more than two teeth
• 10: Debris on palate or sticking to teeth

Challacombe Scale: Severity and Management

• Score 1-3 indicates mild dryness, may not require further management
• Twice daily chewing of sugar-free chewing gum and keeping hydrated can be treatment, follow-up is by regular monitoring
• Score 4-6 indicates moderate dryness, requires sugar-free chewing gum or simple sialogogues.
• Further investigation needed if the cause is unclear, saliva substitutes and fluoride may be helpful, regular follow-ups to check for early dental decay and symptom change are required
• Score 7-10 indicates severe dryness, needs saliva substitutes and topical fluoride
• Reasons for reduced salivation needs assessment, Sjögren's syndrome needs to be excluded, referral required for further investigation and diagnosis, particularly if symptoms and signs worsen

Conclusion

• Xerostomia is an increasingly common debilitating condition
• You will see many patients suffering with this during your career
• Look after them well !